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How to recognize a paranoid personality disorder ?

How to recognize a paranoid personality disorder ?

Paranoid personality disorder is a psychiatric diagnosis characterized by paranoia and a pervasive, long-standing suspiciousness and generalized mistrust of others.

Those with the condition are hypersensitive, are easily slighted, and habitually relate to the world by vigilant scanning of the environment for clues or suggestions to validate their prejudicial ideas or biases. Paranoid individuals are eager observers. They think they are in danger and look for signs and threats of that danger, disregarding any facts. ( Waldinger, 1997).

They tend to be guarded and suspicious and have quite constricted emotional lives. Their incapacity for meaningful emotional involvement and the general pattern of isolated withdrawal often lend a quality of schizoid isolation to their life experience.

Causes


 

A genetic contribution to paranoid traits and a possible genetic link between this personality disorder and schizophrenia exist. Psychosocial theories implicate projection of negative internal feelings and parental modeling.

 

Diagnosis

 


WHO


The World Health Organization's ICD-10 lists paranoid personality disorder as (F60.0) Paranoid personality disorder.

It is characterized by at least 3 of the following:

1. excessive sensitivity to setbacks and rebuffs;
2. tendency to bear grudges persistently, i.e. refusal to forgive insults and injuries or slights;
3. suspiciousness and a pervasive tendency to distort experience by misconstruing the neutral or friendly actions of others as hostile or contemptuous;
4. a combative and tenacious sense of personal rights out of keeping with the actual situation;
5. recurrent suspicions, without justification, regarding sexual fidelity of spouse or sexual partner;
6. tendency to experience excessive self-importance, manifest in a persistent self-referential attitude;
7. preoccupation with unsubstantiated "conspiratorial" explanations of events both immediate to the patient and in the whole world.

 

Includes:

* expansive paranoid, fanatic, querulant and sensitive paranoid personality (disorder)

 

Excludes:

* delusional disorder
* schizophrenia

 

It is a requirement of ICD-10 that a diagnosis of any specific personality disorder also satisfies a set of general personality disorder criteria.

 

Cultural sensitivities


 

World Health Organization, in the ICD-10, points out for different cultures it may be necessary to develop specific sets of criteria with regard to social norms, rules and obligations.


Millon's subtypes


Theodore Millon identified five subtypes of paranoid. Any individual paranoid may exhibit none or one of the following:

* fanatic paranoid - including narcissistic features
* malignant paranoid - including sadistic features
* objurate paranoid - including compulsive features
* querulous paranoid - including negativistic (passive-aggressive) features
* insular paranoid - including avoidant features

 

Differential diagnosis


 

The following conditions commonly coexist (comorbid) with paranoid personality disorder:

* very brief psychotic episodes (lasting minutes to hours)
* delusional disorder
* schizophrenia
* major depressive disorder
* agoraphobia
* obsessive-compulsive disorder
* alcohol and substance-related disorders
* schizoid personality disorder
* schizotypal personality disorder
* narcissistic personality disorder
* avoidant personality disorder
* borderline personality disorder

 

Treatment

 


Because of reduced levels of trust, there can be challenges in treating paranoid personality disorder. However, psychotherapy, antidepressants, antipsychotics and anti-anxiety medications can play a role when an individual is receptive to intervention.

 

Epidemiology


 

Paranoid personality disorder occurs in about 0.5%-2.5% of the general population. It is seen in 2%-10% of psychiatric outpatients. It occurs more commonly in males.

A large long-term Norwegian twin study found paranoid personality disorder to be modestly heritable and to share a portion of its genetic and environmental risk factors with schizoid and schizotypal personality disorder.

 

sources "http://en.wikipedia.org/wiki/Paranoid_personality_disorder"